Neurology & Pain Management Coding Alert

Question: Which code represents a single lumbar plexus block administered for post-op pain? I considered new code 64449 but don't know whether it's appropriate.

Connecticut Subscriber

Answer: You have several options: The first is 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) with modifier -52 (Reduced services). Append modifier -52 because, although the injection procedure is the same, the neurologist does not thread a catheter or provide any post- procedure daily management.
 
Another option is 64483 (Injection, anesthetic and/or steroid, transforaminal epidural; lumbar or sacral, single level). Although this code does not specify "plexus," it might be your closest option because there is no code for a single injection to the lumbar plexus.
 
A final option is 64999 (Unlisted procedure, nervous system). If you report this code, you should also submit documentation and a letter explaining the specific procedure. Compare the injection to a similar procedure, such as 64520 (Injection, anesthetic agent; lumbar or thoracic [paravertebral sympathetic]), so the payer can make an informed payment decision.